She's threatening to 'sign herself out' of NH.

Started by

MIL went from re-hab to long-term care after not making any progress after a recent heart attack. She has many other issues including dementia, possible AZ, hydrocephalus and serious mobility and transfer issues and general self-care deficit. For weeks she has begged and pleaded to go home and now is just mad at everyone and everytime we visit, when she talks to us at all, she has it all planned in her head to 'just leave this place'. She may be able to talk a live-in boyfriend to sign her out AMA as she's very manipulative.

She has refused any in-home hired help in the past (after several falls and two broken bones) and her mindset hasn't changed - according to her, they robbed her of money and jewelry, smoked in her house and didn't feed her (all untrue, of course). She says just her and the boyfriend can 'get by'. Unfortunately the boyfriend is 89 and sickly himself, unable to help her at all physically.

Is there any recourse at this point? She's on an anti-depressant and anti-anxiety meds, but her mood swings are still awful - I'm not sure where her personality ends and where the dementia begins as she's always been very uncooperative and easily agitated. Add extrememly combative to the list now. Her long-time doc tells her she's not safe to go home, but she has stopped listening to him or will smile and nod her head and then go do what she pleases.

What are others' experience with this? I don't know that this doc (a GP) would agree with a guardianship and she absolutely refuses a different or additional doctor. Help!


Consult an elder care attorney for a consultation. They are usually free or there may be a small charge. If not you could call adult protective services and voice your concerns to them. They might be able to keep her in there. Ask the elder care attorney about an emergency guardianship.
I too have the same problem and checked with an elder care attorney, $1000.00 later it appears there is nothing I can do. I am not yet willing to involve Adult Protective Services, I worked with Social Services for years and all I can say is when they get involved, it can just makes things even worse! I have an appointment with the doctor and hope for some help,
My elder care attorney says an emergency guardianship can be done in about 2 weeks and runs about $5000. This is the only way I know of. Sorry I can't help more
Who signed your MIL in? Who if anyone has Durable and or Medical POA? If the long term care facility is anything like the nursing home that my mother is in, the doctor will not let her go home because she is an unsafe discharge to an unsafe home situation. To get guardianship one of more doctors will need to evaluate your MIL and declare her incompetent to manage her business in a business like manner due to her dementia.
Lisbeth, I think like Cmagnum just mention that, "the doctor will not let her go home because she is an unsafe discharge to an unsafe home situation." Especially, if he is the one that put her in the place for she would have to be discharged from under a physician's care to someone else or some place else.
Thank you all so much, it means a lot. We've decided to look for an elder attorney, should it be needed and I appreciate the information!

Cmagnum, her son, my husband, has medical POA. Her doctor sent her to rehab initially and is in charge of her care. She sees him once a month and each time tells her she's too weak to go home - it'll back her off for awhile, then the whole thing starts all over again.

Yes, we've told the boyfriend that whoever took her home would have to sign her out AMA and would be 100% responsible for her care - the NH said they would not send home any meds, paperwork, Rx's, nothing, so hopefully that's enough to dissuade him for the time being.

Today she is weak and weepy and not feeling well at all, so there was no talk of home. Hopefully the doctor will emphasize next week that she still needs to be where she can be safe and cared for.

Lisbeth, I believe the fact that you husband has medical POA overrides both the boyfriend thinking he can sign her out or her signing herself out. Many doctors will not keep you as a patient if you leave a nursing home against their advice. If the boyfriend does this somehow, then not only is he responsible, but your husband is then liable as the Medical POA. I might be wrong, but that is how it was explained to me if I as my mother's medical POA checked mom out against the doctor's wishes.

Does your husband have durable POA for her as well so that he can take care of her finances?

If I were your husband, I would tell the boyfriend that he does not have the authority to check her out, only your husband does as the medical POA.

My step-dad has naively wanted to check my mother out, but he can't override the doctor or me for I'm her medical POA. If he had her at home, she would be dead by now. He does not like my being POA, but I think my mother made a wise decision.

There are times when one lets those who need to know that as POA you are the one with the authority and the buck so to speak stops with you. So, I'd say to your husband and the atty might also, you have the authority as medical POA, use it to protect and care for your mother. She might not like where she is, but she trusted her son to be her medical POA and she is safe and being cared for.
cmagnum, thanks so much for all the helpful advice. After a long talk with the boyfriend, he does understand that he cannot take her home - at least for now. Also, when we took her to her daughter's home for Thanksgiving dinner, even the boyfriend remarked how weak and helpless mil was. It took three over-grown adults to get her about 20 feet to the car and we were carrying her completely about halfway there. Her stamina is getting worse and worse and it's obvious to all (except herself) that there's really no way she can go home.

So for now, things are quiet but she has an appointment with her doc on Monday and is going to 'beg him to go home' she says. Here we go again!

Thanks for taking the time to post.
My husband had to be admitted the to hospital against his will as the 911 responders said since I had the POA, I could override his refusal to be transported, they were right but my husband can be so ugly I knew it would be hard on me, yet, for his sake, I agreed they should transport him. He was admitted for 4 days with a kidney infection and the whole time there, he was telling everyone how evil I was and he was turning on the charm and the manipulation of all the hospital staff and they were beyond rude to me when I would go see him. He was demanding I agree to him discharging himself AMA and I told him 'no' and told the hospital staff not to let him do that because he has did it before and checked himself out of rehab after a fall. So on day four I got a very NASTY call from the hospitalist who was handling my husbands care and he started off by saying "Listen lady, you have no authority to prevent your husband from self discharging AMA and that POA doesn't give you any rights..UNLESS you are telling me you have conservatorship!" I was dumbfounded at how rude he was and in tears. I picked my husband up at 6PM that same day as the doctor sent him home for me to care for him and he was still very sick. Then my husband turned off his 'charming' side and returned to being verbally abusive toward me. His side of the family sided with him at the time and I was seen as the bad guy and probably still viewed as such. All I was doing was trying to get him the care he needed for a severe kidney infection and he only has one kidney. Caretaking is bad enough for the spouse or family but when the medical community dumped on me and then his family, I cannot begin to tell how incredibly painful it was/is. So, back to topic, I also was told later that if my husband had gone ahead and left the hospital AMA, that Medicare would NOT have paid for the ER or the four days after he was admitted. Bottom line, the POA may mean nothing, depending on what the rules are for the hospital or care facility or rehab placement.
A note to all, my mother-in-law died quietly this morning with my husband and his sister by her side. She never did sign herself out or even get to go home as she wanted, though her physical health did improve enough for her doctor to consider it as late as last week at her regular appointment. She quietly had another heart 'event' last night and simply quit breathing early this morning, dying peacefully. Thank you all so much for listening and helping and for your kind advice...Liz.

Keep the conversation going (or start a new one)

Please enter your Comment

Ask a Question

Reach thousands of elder care experts and family caregivers
Get answers in 10 minutes or less
Receive personalized caregiving advice and support